Thursday, June 28, 2007

In HOOKED, I wrote that it seemed that problems with conflicts of interest and accepting gifts and money from the drug industry was more of a problem in psychiatry than in other medical specialties--but that I could not be sure as it might merely have been that conflicts in psychiatry received more attention.

Now some evidence comes forward to suggest that the psychiatrists, after all, may get the skunk cabbage award for the most on-the-take specialty. Gardiner Harris has concluded, from his research into the records of drug company gifts to docs in VT and MN, that the shrinks come out on top. Indeed, in VT, company payments to psychiatrists went from $20,835 on average in 2005 to $45,692 in 2006. (The range per psychiatrist in MN, in case you are interested, is from $51 to $689,000. The poor schlub who only got $51 really needs to hire a new agent.)

The controversy over gifts paid by the pharmaceutical industry to try to influence physicians' prescribing practices is attracting increasing legislative attention.

Currently, CA, ME, WV, and DC have laws mandating disclosure of payments to doctors, while VT and MN have laws that also mandate availability of some of these data to the public. More than a dozen other states, including WI and TX, have had proposals introduced in the legislature. Recent investigative reporting by the New York Times, based mainly on the MN data, has shown how devastating to industry and physicians' reputations even a limited glimpse can be. The Times, for example, showed a correlation between how much child psychiatrists were paid by comapnies, and how likely they were to prescribe some controversial and expensive drugs for Medicaid patients.

Now the US Senate is taking notice. Yesterday's committee hearings featured an interesting exchange between Sen. Claire McCaskill, D-MO, and Marjorie Powell, senior assistant general counsel to PhRMA. Ms. Powell trotted out the usual PhRMA party line that the code of ethics imposed in 2003 had reined in inappropriate gifts to physicians and severely limited what is allowable. Sen. McCaskill replied that her brother who runs a restaurant told her that the private room hired by the drug companies to entertain doctors is the most lucrative part of his business, especially the tabs for expensive wine that often run into the thousands of dollars.

Ms. Powell politely suggested that Sen. McCaskill was misinformed and that no such events could have occurred in recent years. Sen. McCaskill politely implied that Ms. Powell was full of it. The audience seemed to buy the Senator's version, apparently figuring that a restaurant owner would actually know how much money was being spent in his establishment.

Harris, Gardiner. Senators push for registry of drug makers' gifts to doctors. New York Times, June 28, 2007.